ch 32- MH

The parent of a seriously mentally ill adult asks the nurse, "Why are you making a referral to a vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply?

"Most patients are capable of employment at some level, competitive or supported."

Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate?

"Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses."

A person diagnosed with a SMI enters a shelter for the homeless. Which intervention should be the nurse's initial priority?

Develop a trusting relationship.

A person diagnosed with a SMI living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and SMI in general are accurate? (Select all that apply.)

Impaired judgment and socialNskUiRllSsINcaGnTpBr.CoOvoMke hostile or assaultive behavior. Lower incomes force SMI persons to live in high-crime areas, increasing risk. SMI persons experience higher rates of sexual assault and victimization than others. Criminals may believe SMI persons are less likely to resist or testify against them.

The sibling of a patient who was diagnosed with a SMI asks why a case manager has been assigned. The nurse's reply should cite the major advantage of the use of case management as:

"Case managers coordinate services and help with accessing them, making sure the patient's needs are met."

A person diagnosed with SMI has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? (Select all that apply.)

Develop written plans that will help the patient remember what to do in a crisis. Help the patient identify and anticipate events that are likely to be overwhelming. Encourage health-promoting activities such as exercise and getting adequate rest. Accompany the patient to a NAMI support group.

A family discusses the impact of a seriously mental ill member. Insurance partially covers treatment expenses, but the family spends much of their savings for care. The patient's sibling says, "My parents have no time for me." The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful?

Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.

A homeless individual diagnosed with SMI and a history of persistent treatment nonadherence plans to begin attending the day program at a community mental health center. Which intervention should be the team's initial focus?

Interact regularly and supportively without trying to change the patient.

A hospitalized patient diagnosed with schizophrenia has a history of multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the patient transitions from hospital to community?

Involve the patient in decisions about which medication is best.

A patient diagnosed with a SMI lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." Select the nurse's best action.

Involve the patient's case manager to provide crisis intervention.

The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? (Select all that apply.)

Make it easier to access prescribers and pay for drugs. Maintain stable and consistent staff.

Which statements most clearly indicate the speaker views mental illness with stigma? (Select all that apply.)

"We are all a little bit crazy." "If people with mental illness would go to church, their problems would be solved." "People with mental illness are lazy. They get government disability checks instead of working."

Which nursing diagnosis is likely to apply to an individual diagnosed with a SMI who is homeless?

Chronic low self-esteem

For patients diagnosed with SMI, what is the major advantage of case management?

With one coordinator of services, resources can be more efficiently used.

SMI is characterized as

a major long-term mental illness marked by significant functional impairments.

A patient diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." The nurse identifies the etiology of the patient's ineffective management of the medication regime as

impaired reasoning secondary to the schizophrenia.

A homeless patient diagnosed with a SMI became suspicious and delusional. Depot antipsychotic medication began and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement?

"I feel comfortable here. Nobody bothers me."

An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The patient says, "I threw away the pills because they keep me from hearing God." Which response by the nurse would most likely to benefit this patient?

"I noticed that when you take the medicine, you are able to keep the job you wanted."

The nurse wants to enroll a patient with poor social skills in a training program for patients diagnosed with schizophrenia. Which description accurately describes social skills training?

Complex interpersonal skills are taught by breaking them into simpler behaviors.

An outpatient diagnosed with schizophrenia tells the nurse, "I am here to save the world. I threw away the pills because they make God go away." The nurse identifies the patient's reason for medication nonadherence as

thought disturbances associated with the illness.

Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with SMI?

Assertive community treatment (ACT)

A consumer at a rehabilitative psychosocial program says to the nurse, "People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered." How should the nurse respond?

Encourage the consumer to discuss it at a meeting with everyone.

A patient diagnosed with a SMI died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, "How could this happen?" Which response by the nurse accurately reflects research and addresses the family's question?

"Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight."

A nurse's neighbor says, "My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?" Select the nurse's best response.

"NAMI offers a family education series that you might find helpful."

A patient diagnosed with SMI was living successfully in a group home but wanted an apartment. The prospective landlord said, "People like you have trouble getting along and paying their rent." The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? (Select all that apply.)

Coach the patient in ways to control symptoms effectively. Seek out landlords less affected by the stigma associated with mental illness. Have the case manager meet with the landlord to provide education about mental illness.

An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Where should the nurse refer the patient? (Select all that apply.)

Psychoeducational classes Vocational rehabilitation Social skills training

A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, "You cause too much trouble." What problem is the patient experiencing?

Stigma

An adult diagnosed with a serious mental illness (SMI) says, "I do not need help with money management. I have excellent ideas about investments." This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating

anosognosia.

After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of

dependency caused by institutionalization.